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Letters to the Editor

Fibrosing Colonopathy

Couper, Richard T. L.

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Journal of Pediatric Gastroenterology and Nutrition: April 2003 - Volume 36 - Issue 4 - p 507-508
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To the Editor:

Serhan et al. (1) reports fibrosing colonopathy in a cystic fibrosis neonate who presented initially with meconium ileus. A diagnosis of cystic fibrosis was made after he represented on day 21 and surgical resection of a small segment of his terminal ileum was undertaken. Histopathology suggested fibrosing colonopathy. Before presenting for treatment, he had not received pancreatic enzyme supplements.

Post operatively the patient had diarrhea and was treated with unspecified antibiotics. Increased permeability and the possibility of a modifier focus are suggested as possible mechanisms underpinning this state by both the authors and Christopher Taylor in his editorial.

There is another possibility. It is conceivable that the findings are unrelated to cystic fibrosis. Furman et al. (2) reported three infants with a staphylococcal toxin mediated enteropathy and severe persistent diarrhea early in life. The diarrhea was initially culture negative for Staphylococcus aureus. Appropriate culture medium allowed this organism to grow and anti-staphylococcal therapy resulted in the resolution of the symptoms. We have seen a similar course in a two-month old infant with nonbilious vomiting, failure to thrive, low albumen, and a high platelet count. Gastroduodenoscopy was normal. Extensive investigation did not reveal a cause. Barium studies and abdominal ultrasound revealed thickness of the small bowel. Stool microscopy revealed polymorphs but no pathogens were cultured. While under treatment with prednisolone, the patient underwent a laparoscopic biopsy of her bowel. Subsequently she perforated her jejunum and required resection of 12 cm of jejunum. She was found to have extensive mucosal ulceration and fibrosis as well as full-thickness inflammation. There was unusual intimal proliferation in the blood vessels. At her first laparoscopy, Staphylococcus aureus was isolated from peritoneal fluid. After resection, treatment with antibiotics including gentamicin and total parental nutrition, she made a complete recovery.

Staphylococcus aureus is a common infecting agent in cystic fibrosis (3) and has now been shown to be linked to severe enteropathy early in life. Is it not possible that the so-called fibrosing colonopathy reported by Serhan is epiphenomenal secondary to staphylococcal infection?

Richard T. L. Couper

REFERENCES

1. Serhan DE, Florescu P, Miu N. Fibrosing colonopathy revealing cystic fibrosis in a neonate before any pancreatic enzyme supplementation. J Pediatr Gastroenterol Nutr 2002; 35:356–59.
2. Furman M, Hicks S, Perez-Machado M, Toffente F, Curtis N, Phillips AD, Walker-Smith JA, Murch SH. Staphylococcal toxin mediated enteropathy and severe persistent malabsorption in three infants. J Pediatr Gastroenterol Nutr 2001; 32;356 Abstract 44.
3. Dinwiddie R. Pathogenesis of lung disease in cystic fibrosis. Respiration 2000; 67:3–8.
© 2003 Lippincott Williams & Wilkins, Inc.